Lucknow: For millions of Indians living with cancer, advanced heart disease, neurological disorders and age-related illnesses, the biggest challenge is often not treatment itself but access to comfort, pain relief and supportive care. As World Hospice and Palliative Care Day is observed on Oct 10, experts say India needs to move beyond a hospital-centric approach and focus on bringing palliative care closer to patients’ homes.




Kerala ’s experience offers an example of how such a model can work. Over the last three decades, the state has developed a vast community-based palliative care network that combines govt institutions, local bodies, volunteers and healthcare professionals. The system relies heavily on home visits , allowing bedridden and seriously ill patients to receive support without repeatedly travelling to hospitals.




The scale of the programme is substantial. Kerala reports more than 1,100 primary palliative-care units and an extensive network of home-based services supported by community organisations. The state’s palliative-care grid integrates govt institutions and voluntary groups to track and support thousands of bedridden patients.




The contrast becomes evident in home-care outreach. Govt data for 2024-25 shows Kerala carried out nearly 9.8 lakh home visits for palliative care, while Uttar Pradesh recorded around 33,800. While the two states differ considerably in population, geography and healthcare structures, the figures underline a major gap in last-mile delivery of care.




Uttar Pradesh has made progress under the National Programme for Palliative Care , which has expanded services across districts. However, healthcare experts say the next challenge is ensuring that palliative support reaches elderly, frail and bedridden patients who may be unable to travel to healthcare facilities.




According to Dr Abhishek Shukla , geriatric and palliative-care specialist at Aastha Centre of Geriatric Medicine, Palliative Care & Hospice, pain management should not be viewed merely as reducing a score on a pain scale.




“The real question is what pain is preventing a patient from doing. Is it stopping them from sleeping, eating, walking or spending time comfortably with family?” he said.




Dr Shukla said pain is often influenced by emotional, psychological and social factors, making individualised assessment critical. Effective palliative care may involve medicines, physiotherapy, counselling, mobility support and caregiver education, depending on the patient’s needs.




He stressed that palliative care is not about giving up on treatment. Instead, it focuses on relieving suffering, preserving dignity and helping patients maintain the best possible quality of life alongside ongoing medical care.




For Uttar Pradesh, experts believe the future lies in integrating palliative care with primary healthcare, strengthening home-based services and involving local communities. “The goal is not just creating more facilities,” Dr Shukla said, “but ensuring that care reaches the patient who needs it most.”




As healthcare systems grapple with ageing populations and rising chronic illnesses, that may ultimately be the true test of palliative care: not how many units exist on paper, but how effectively they can bring comfort and dignity to a person’s doorstep.